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Postnatal Corticosteroids (postnatal + corticosteroid)

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Medical Sciences100%

Selected Abstracts

Postnatal corticosteroids and sensorineural outcome at 5 years of age

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 3 2000
The Victorian Infant Collaborative Study Group
Background: Postnatal corticosteroids reduce ventilator dependence in preterm infants, but possible long-term benefits for either survival or sensorineural morbidity are not proved. Aim: The aim of this study was to determine the association between corticosteroid therapy given postnatally and sensorineural outcome in childhood. Subjects: The subjects comprised 346 consecutive livebirths either of birthweight < 1000 g or with gestational age < 28 weeks born in the state of Victoria during 1991 and 1992, and who survived the first week after birth; 120 (34.7%) were given corticosteroids postnatally. Results: Of the 120 children who received corticosteroids, 98 (81.7%) survived to 5 years of age, compared with 200 (88.5%) of the 226 children who did not receive corticosteroids. At 5 years of age, survivors treated with corticosteroids postnatally had significantly higher rates of cerebral palsy (corticosteroids 23%, no corticosteroids 4%), blindness (corticosteroids 4%, no corticosteroids 1%) or an intelligence quotient more than one standard deviation below the mean (corticosteroids 54%, no corticosteroids 32%) compared with children not treated with corticosteroids. The rate of sensorineural disabilities imposed by these impairments was significantly higher in children treated with postnatal corticosteroids, and the association between adverse sensorineural outcome and postnatal corticosteroids remained after adjustments for potentially confounding variables. In a separate case-control analysis of 60 children in each group, the rate of cerebral palsy remained significantly elevated (corticosteroids 22%, no corticosteroids 5%). Conclusion: Postnatal corticosteroid therapy is associated with substantial adverse sensorineural outcomes at 5 years of age. [source]

Postnatal corticosteroids in preterm infants: Systematic review of effects on mortality and motor function

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 2 2000
LW Doyle
Background: Postnatal corticosteroid therapy has been proved in randomized controlled trials to reduce ventilator dependence and the rate of chronic lung disease in preterm infants with few serious short-term side effects. However, there are other consequences that might follow postnatal corticosteroid therapy that are more important, including mortality or cerebral palsy. Objectives: To review the evidence from reported randomized controlled trials on the effects of postnatal corticosteroid on long-term mortality and motor dysfunction, including cerebral palsy. Methods: The methods involved a meta-analysis of reported randomized controlled trials, following guidelines of the Cochrane Collaboration, including calculation of event rate differences (ERD) and 95% confidence intervals (CI). Results: The mortality rate difference was non-significant both statistically and clinically (ERD , 0.1% favouring corticosteroids, 95% CI ,2.9% to 2.8%). There were no subgroups in which a beneficial effect of postnatal corticosteroids on survival could be demonstrated. The rate of motor dysfunction in survivors was significantly higher in survivors from the postnatal corticosteroid group (ERD 11.9% favouring controls, 95% CI 4.6% to 19.2%). The rate of survival, free of motor dysfunction, was significantly lower in the postnatal corticosteroid group (ERD 7.8% favouring controls, 95% CI 0.5% to 15.1%). Conclusions: Although postnatal corticosteroids have short-term benefits, they do not increase the survival rate, and they may cause motor dysfunction in survivors. A large-scale, placebo-controlled randomized trial, with survival free of sensorineural impairments and disabilities as the major endpoint, is urgently needed. [source]

Corticosteroids for the treatment and prevention of chronic lung disease

ACTA PAEDIATRICA, Issue 8 2003
R. F. Soll
Postnatal corticosteroids may prevent chronic lung disease in ventilated very low birthweight infants. However, concern regarding serious neurodevelopmental consequences of therapy has led to strong recommendations to curtail use of this treatment. Conclusion: Despite the high risk of severe neurological side effects, centers in Europe and North America continue to utilize postnatal corticosteroids, frequently in a fashion that is not supported by the available evidence. [source]

Postnatal dexamethasone: what is the real cost-benefit ratio?

ACTA PAEDIATRICA, Issue 8 2003
HL Halliday
Postnatal corticosteroids given early after birth reduce the risk of chronic lung disease in preterm infants but are associated with an approximate doubling of the risk of adverse neurosensory outcomes. Corticosteroids given after 7,10 d of age appear not to have these increased risks of neurosensory sequelae and reduce time on the ventilator. Conclusion: Further research is needed to determine the lowest dose of corticosteroid that will improve lung function and minimize risks to the developing brain. [source]

Postnatal corticosteroids in preterm infants: Systematic review of effects on mortality and motor function

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 2 2000
LW Doyle
Background: Postnatal corticosteroid therapy has been proved in randomized controlled trials to reduce ventilator dependence and the rate of chronic lung disease in preterm infants with few serious short-term side effects. However, there are other consequences that might follow postnatal corticosteroid therapy that are more important, including mortality or cerebral palsy. Objectives: To review the evidence from reported randomized controlled trials on the effects of postnatal corticosteroid on long-term mortality and motor dysfunction, including cerebral palsy. Methods: The methods involved a meta-analysis of reported randomized controlled trials, following guidelines of the Cochrane Collaboration, including calculation of event rate differences (ERD) and 95% confidence intervals (CI). Results: The mortality rate difference was non-significant both statistically and clinically (ERD , 0.1% favouring corticosteroids, 95% CI ,2.9% to 2.8%). There were no subgroups in which a beneficial effect of postnatal corticosteroids on survival could be demonstrated. The rate of motor dysfunction in survivors was significantly higher in survivors from the postnatal corticosteroid group (ERD 11.9% favouring controls, 95% CI 4.6% to 19.2%). The rate of survival, free of motor dysfunction, was significantly lower in the postnatal corticosteroid group (ERD 7.8% favouring controls, 95% CI 0.5% to 15.1%). Conclusions: Although postnatal corticosteroids have short-term benefits, they do not increase the survival rate, and they may cause motor dysfunction in survivors. A large-scale, placebo-controlled randomized trial, with survival free of sensorineural impairments and disabilities as the major endpoint, is urgently needed. [source]

Postnatal corticosteroids and sensorineural outcome at 5 years of age

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 3 2000
The Victorian Infant Collaborative Study Group
Background: Postnatal corticosteroids reduce ventilator dependence in preterm infants, but possible long-term benefits for either survival or sensorineural morbidity are not proved. Aim: The aim of this study was to determine the association between corticosteroid therapy given postnatally and sensorineural outcome in childhood. Subjects: The subjects comprised 346 consecutive livebirths either of birthweight < 1000 g or with gestational age < 28 weeks born in the state of Victoria during 1991 and 1992, and who survived the first week after birth; 120 (34.7%) were given corticosteroids postnatally. Results: Of the 120 children who received corticosteroids, 98 (81.7%) survived to 5 years of age, compared with 200 (88.5%) of the 226 children who did not receive corticosteroids. At 5 years of age, survivors treated with corticosteroids postnatally had significantly higher rates of cerebral palsy (corticosteroids 23%, no corticosteroids 4%), blindness (corticosteroids 4%, no corticosteroids 1%) or an intelligence quotient more than one standard deviation below the mean (corticosteroids 54%, no corticosteroids 32%) compared with children not treated with corticosteroids. The rate of sensorineural disabilities imposed by these impairments was significantly higher in children treated with postnatal corticosteroids, and the association between adverse sensorineural outcome and postnatal corticosteroids remained after adjustments for potentially confounding variables. In a separate case-control analysis of 60 children in each group, the rate of cerebral palsy remained significantly elevated (corticosteroids 22%, no corticosteroids 5%). Conclusion: Postnatal corticosteroid therapy is associated with substantial adverse sensorineural outcomes at 5 years of age. [source]

Postnatal corticosteroids in preterm infants: Systematic review of effects on mortality and motor function

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 2 2000
LW Doyle
Background: Postnatal corticosteroid therapy has been proved in randomized controlled trials to reduce ventilator dependence and the rate of chronic lung disease in preterm infants with few serious short-term side effects. However, there are other consequences that might follow postnatal corticosteroid therapy that are more important, including mortality or cerebral palsy. Objectives: To review the evidence from reported randomized controlled trials on the effects of postnatal corticosteroid on long-term mortality and motor dysfunction, including cerebral palsy. Methods: The methods involved a meta-analysis of reported randomized controlled trials, following guidelines of the Cochrane Collaboration, including calculation of event rate differences (ERD) and 95% confidence intervals (CI). Results: The mortality rate difference was non-significant both statistically and clinically (ERD , 0.1% favouring corticosteroids, 95% CI ,2.9% to 2.8%). There were no subgroups in which a beneficial effect of postnatal corticosteroids on survival could be demonstrated. The rate of motor dysfunction in survivors was significantly higher in survivors from the postnatal corticosteroid group (ERD 11.9% favouring controls, 95% CI 4.6% to 19.2%). The rate of survival, free of motor dysfunction, was significantly lower in the postnatal corticosteroid group (ERD 7.8% favouring controls, 95% CI 0.5% to 15.1%). Conclusions: Although postnatal corticosteroids have short-term benefits, they do not increase the survival rate, and they may cause motor dysfunction in survivors. A large-scale, placebo-controlled randomized trial, with survival free of sensorineural impairments and disabilities as the major endpoint, is urgently needed. [source]

Cognitive outcome at 2 years of age in Finnish infants with very low birth weight born between 2001 and 2006

ACTA PAEDIATRICA, Issue 3 2010
P Munck
Abstract Aim:, To study cognitive outcome of premature, very low birth weight (VLBW) infants in relation to parental education and neonatal data. Methods:, A regional cohort of 182 VLBW infants born between 2001 and 2006 was followed up. Brain ultrasounds (US) were examined serially until term age and brain magnetic resonance imaging at term age. Neurological status was examined systematically. Cognitive development was assessed using the Mental Developmental Index (MDI) of Bayley Scales at 2 years of corrected age. A total of 192 healthy full-term (FT) controls were assessed with the MDI at 2 years of age. Results:, The mean MDI in VLBW infants was 101.7 (SD 15.4), which was lower compared with FT controls (109.8, SD 11.7, p < 0.001). In regression analysis of the demographic and medical data of VLBW infants, postnatal corticosteroids (p = 0.04), intestinal perforation (p = 0.03) and major brain pathology (p = 0.02) were negatively associated with the MDI. In VLBW infants, the prevalence of neurodevelopmental impairment was 9.9% (3.3% MDI below 70, 7.1% cerebral palsy, 2.2% hearing aid, no blind infants). Conclusion:, Cognitive development of VLBW infants seemed to have improved in comparison with earlier publications, but it differed from the FT controls. Neonatal factors affected cognitive development. Therefore, updated regional follow-up data are important for clinicians. [source]

Corticosteroids for the treatment and prevention of chronic lung disease

ACTA PAEDIATRICA, Issue 8 2003
R. F. Soll
Postnatal corticosteroids may prevent chronic lung disease in ventilated very low birthweight infants. However, concern regarding serious neurodevelopmental consequences of therapy has led to strong recommendations to curtail use of this treatment. Conclusion: Despite the high risk of severe neurological side effects, centers in Europe and North America continue to utilize postnatal corticosteroids, frequently in a fashion that is not supported by the available evidence. [source]